Question:
Discuss about the Contributing Factors To Brian’s Continence.
The aim of the report is to respond to the case study of Mr. Brian experiencing incontinence. The contributing factors to the incontinence and the continence issues are discussed. To promote continence in Brian, health promotion involves the process of increasing his control over and improves the health. For this purpose two-research articles on one initiative or innovation program is critically analysed and based on the evidence obtained the report recommends how registered nurses can improve personal practice and the practice of others.
Incontinence and the problems related to continence are the indicators of the bladder and bowel dysfunction. It is the most common problem occurring in the old age but is never normal. Thus, age is not causative e but contributing factor for incontinence, which is also found in case of Brian (Watt et al. 2014). He is 82 years old man and his age may be considered contributing factors for his continence problems.
According to Johnson and Chang (2014), urinary and faecal incontinence in elderly patients is caused by strokes. From the patient history, it can be interpreted that the ischemic heart diseases and heart failure is the contributing factor of Brian’s faecal and urinary incontinence. Bladder dysfunction also results from the spinal disorders and osteoarthritis (Bedretdinova et al. 2016). In neurogenic bladder disorder there is damage to the nerve tissues that control the functioning of the bladder and the muscles involved in urination and bowel movement. Brian’s, spondylitis may be the other contributing factor (Panicker et al. 2015). The possible complications of spondylitis are the urinary and faecal continence (Bagnola et al. 2017).
Not drinking enough water is the contributing factor for inflamed bladder wall. In case of Brian, it was seen he consumed more of wine and coffee and less of water. Drinking tea or coffee aggravates the bladder, which makes the incontinence a likely occurrence (Watt et al. 2014). Wine acts as a bladder stimulant (Johnson and Chang 2014). Faecal incontinence can be caused by constipation. Brian opens his bowel every 2-3 days. Thus, constipation may be the contributing factor for the continence issues observed in Brian. According to Loening?Baucke and Swidsinski (2015) faecal impaction causes difficult bowel moment and is the cause of the lower gastrointestinal tract obstruction. It is commonly found in elderly people with the constipation. The same may be the causative factor of Brian bowel problems and it was found from the case study that his abdominal examination showed lower left abdominal faecal masses.
Since, Brian is undergoing treatment and medication for his ailments; the side effects of the medicines are having adverse effects on his bladder function. Brian is taking frusemide and spiractin, which is diuretic that increases urine volume. Amiodorone taken by him shows the beta blocker-like and calcium channel blocker-like actions and is known for urinary incontinence and constipation. Brian also takes tramadol which is the opioid that causes the reduce bladder contractions, constipation (Hussain and Gill 2016).
The main urinary incontinence issues faced by Brian is the voiding of urine 9-12 times a day and 2-3 times overnight, he feels the urgency to void on most occasions. Sometimes Brian is not aware of leakage. He opens his bowel every 2-3 days and each bowel action is associated with straining and urgency. These issues can be categorised as urge continence in Brian. Urge continence refresh to the condition where the loss of urine is accompanied with the urgent need to urinate. This mainly occurs due to involuntary actions of the bladder after stroke (Johnson and Chang 2014). Brian condition can also be related to the overflow continence. It is the condition where the bladder never completely empties. It is due to this reason that Brian voids urine 3-4 times a day with small volume of urine loss. Brian’s functional incontinence that is unable to make up to the bathroom at night. It can be caused by the stroke complications and the neurological disorder that he is having. His mind cannot carry or plan the trip to bathroom (Watt et al. 2014).
Incontinence in elderly patients is difficult to treat, as they are reluctant to seek help due to embarrassment. Lack of awareness and effective communication with the health care providers is the other major cause of poor services (Watt et al. 2014). It can be concluded that Brian needs comprehensive health care plan because he is having chronic heart illness along with several comorbidities that result in interrelated complications. This demands the multifaceted approach. Thus, the nursing care plan must address the health issues using evidence-based practice. There is a need of joint approach and strategies for achieving the best outcome for Brian considering his age, coronary heart disease, spondylitis, incontinence, walking disability and overall weakness (De Gagne et al. 2015).
Article 1
In the article by De Gagne et al. (2015), the aim of the pilot study is to develop, implement and determine the effectiveness of the self-management program that is evidence based for community-dwelling older women (aged 55 years) with urinary incontinence in South Korea. The rational for conducting this study is evident from the succinct background provided by the author that demonstrates the through literature review being conducted (Schneider and Whitehead 2013). Thus, the objective of the paper is justified by the following objectives-
Considering the research objectives the research topic was well justified although there was no hypothesis given.
The study uses quantitative research paradigm and involves a one-group pre- post-test design. The instrument used for the data collection includes “Sociodemographic questionnaire, knowledge scale and attitude scale, ICIQ-SF, Short Assessment Patient Satisfaction, Fidelity evaluation checklist. The research design is justified as the methodology is well described in terms of the participants and each of the instrument used for data collection is well explained. It constitutes the strength of the study as it eliminates the limitations by detailed description of participants, the inclusion and exclusion criteria that were found justified (LoBiondo-Wood and Haber 2017). The author had clearly mentioned the setting of the research as Sosa community (Korean rural community) but the lack of details on it is inconvenient for the readers. The research seems to be reliable. Obtaining ethics approval implies that the ethical issues were taken into considerations (Moralejo et al. 2017).
In the study, 17 women participated and completed weekly 90-min group sessions for 5 weeks. The strength of intervention emerges from the teaching topics that are described in lucid language. However, drawback involves lack of details on the sampling method (LoBiondo-Wood et al. 2014). It includes self-management principles, behavioral and lifestyle factors on bladder health, effective communication, myths and facts about UI, and interactions with family and friends.
The limitation of the study is the lack of sufficient description of data analysis. However. It was justified that the study used descriptive statistics and paired t-tests. The results are well documented by the author in form of tabulated charts with flawless presentation of the statistical values (p < 0.05). The presentation of the results under individual subheadings gives the readers an in-depth insight of the study outcomes. Acknowledgement of the limitations adds to the strength of the study (Coughlan et al. 2007).
The findings of the study showed an improved outcomes with the implementation of the self-management program of the urinary incontinence despite the scarce resources in the rural communities for urinary incontinence management and treatment. The findings are clearly stated by the author emphasising on the potential of this program and its widespread implementation in the nursing practice. This constitutes the strength of the study as the results were found to be statistically significant. However, there should have been more details on validity although the research appears reliable (Moralejo et al. 2017).
Overall, it can be concluded from the quantitative study that increase in the self-management of the disease was found by an increase in the knowledge and positive attitudes toward it.
Article 2
In the article by the Wilde et al. (2014), the aim is to discuss the “the principles of self-management and their application in treating urinary and faecal incontinence”. The objective of the paper justifies the research aims and appears relevance. The objective is to describe the patient’s benefits by applying the self-management techniques to address incontinence together with the case scenario.
The author initially detailed the key elements of the self-management and highlights on the patient management of the physical, psychosocial, emotional, and functional aspects of health. The need of patient self-efficacy and participation in the collaborative process of care implies for the role of the nurse. The strength of the review paper is emphasis on the three processes that a patient requires for self-management of illness. It includes “focussing on illness needs, making use of health care resources, and living with the chronic illness”. The strength of the paper is the thorough literature review along with the support of relevant theories (Aveyard 2014).
The author further elucidates the precondition for success for self-management of urinary or faecal incontinence. The treatment of any underlying etiologies is the precondition. The author highlights the six specific self-management behaviours that come into play during the self-management. It includes-
The strength of the paper further emerges from the explanation of each of six steps that acts as a framework for the nurses and the patients to promote the continence and self-efficacy in patients (Kisely and Kendall 2011). This can be considered advantage as it is not possible to deliver the supporting interventions without these strategies. Highlighting these options may be considered the merits of research.
The limitation of the review paper comes from the use of case scenario from author’s persona experience. It makes the results and conclusions unreliable. The author had not mentioned search strategy for other papers used in the study and there is no details on the validity and reliability of study (Aveyard 2014).
The results of the paper showed that the patient Donna Spencer, 69, diagnosed with urinary incontinence, after six week of self-management found improvement in her condition. The patient modified the amount of the fluid intake (less tea, and coffee and more water), engaged in exercises for pelvic floor muscle, the rapid pelvic contraction exercises, underwent the bladder training (cognitive motivation), including modifying voiding intervals, reduced weight, and lastly constipation management (Wilde et al. 2014). The strength of the paper comes from the strategies for managing faecal or dual incontinence such as dietary modification use of toilet supplies to prevent leakage etc. This informs the readers on how to implement the strategies.
Overall, this article provides evidence, even though of low quality on improvement of urinary incontinence by self-management using evidence based strategies.
Recommendations and Conclusions
Based on the above discussion it can be concluded that the registered nurses should not only focus on the Brian’s medical aspects but also on the psychosocial, functional, and behavioural aspects of wellbeing. While implementing the intervention the role of the nurses for patients like Brian in promoting the urinary incontinence should be to educate patients on self-management of urinary incontinence (De Gagne et al. 2015). The nurse must help Brian focus on illness, make use of social, spiritual and environmental support and help the patients to make practical lifestyle modifications. It may include decrease coffee consumption for Brian. The nurse can promote the six specific self-management behaviours for patients with urinary incontinence mentioned in the above article.
The nurse must implement person-centered care and encourage other nurses to do the same. In this approach, the nurse demonstrates sensitivity to changes in care delivery. In personal practice, the nurse must increase engagement in “Clinical, educational, managerial, audit and research activities” (Hägglund et al. 2017). The rationale for this engagement is to implement the evidence-based practice. It will enhance their contribution to continence care. Evidence based practice helps the nurses feel more comfortable to asses patients with faecal and urinary incontinence. The nurses must collaborate with their colleagues who are Specialist Continence Physiotherapist (Hägglund and Olai 2016). Implementing this recommendation will help a nurse to influence the practice of other nurses as well.
It can be concluded from the critical analysis that care plan for Brian must involve educating patient on self-management strategies for urinary incontinence. The self-management may include adequate fluid intake, a healthy diet, healthy lifestyle, effective toilet habits and pelvic floor muscle maintenance.
References
Aveyard, H., 2014. Doing a literature review in health and social care: A practical guide. McGraw-Hill Education (UK).
Bagnola, E., Pearce, E. and Broome, B., 2017. A Review and Case Study of Urinary Incontinence. Madridge J Nurs, 2(1), pp.27-31.
Bedretdinova, D., Fritel, X., Zins, M. and Ringa, V., 2016. The effect of urinary incontinence on health-related quality of life: is it similar in men and women?. Urology, 91, pp.83-89.
Coughlan, M., Cronin, P. and Ryan, F., 2007. Step-by-step guide to critiquing research. Part 1: quantitative research. British journal of nursing, 16(11), pp.658-663.
De Gagne, J.C., So, A., Wu, B., Palmer, M.H. and McConnell, E.S., 2015. The effect of a urinary incontinence self-management program for older women in South Korea: A pilot study. International Journal of Nursing Sciences, 2(1), pp.39-46.
Hägglund, D. and Olai, L., 2016. Enabling and inhibitory factors that influenced implementation of evidence-based practice for urinary incontinence in a nursing home. Nordic Journal of Nursing Research, p.2057158516667644.
Hägglund, D., Mooney, T. and Momats, E., 2017. Nursing staff´ s experiences of providing toilet assistance to elderly nursing home residents with urinary incontinence. Open Journal of Nursing, 7(2), pp.145-157.
Hussain, M. and Gill, S.S., 2016. 4.4 Anticholinergic Drugs and Inappropriate Medications in Older Adults. Geriatric Psychiatry Review and Exam Preparation Guide: A Case-Based Approach, p.356.
Johnson, A. and Chang, E., 2014. Caring for older people in Australia: Principles for nursing practice.
Kisely, S. and Kendall, E., 2011. Critically appraising qualitative research: A guide for clinicians more familiar with quantitative techniques. Australasian Psychiatry, 19(4), pp.364-367.
LoBiondo-Wood, G. and Haber, J., 2017. Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences.
LoBiondo-Wood, G., Haber, J., Cameron, C. and Singh, M., 2014. Nursing Research in Canada-E-Book: Methods, Critical Appraisal, and Utilization. Elsevier Health Sciences.
Loening?Baucke, V. and Swidsinski, A., 2015. Treatment of functional constipation and fecal incontinence. Pediatric Incontinence: Evaluation and Clinical Management, p.163.
Moralejo, D., Ogunremi, T. and Dunn, K., 2017. Critical Appraisal Toolkit (CAT) for assessing multiple types of evidence. CCDR, 43(9), p.177.
Panicker, J.N., Fowler, C.J. and Kessler, T.M., 2015. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. The Lancet Neurology, 14(7), pp.720-732.
Schneider, Z. and Whitehead, D., 2013. Nursing and midwifery research: methods and appraisal for evidence-based practice. Elsevier Australia.
Watt, Elizabeth & Cassells, Colin 2014, ‘Promoting continence in older people’, in Chang, Esther & Johnson, Amanda Caring for older people in Australia : principles for nursing practice, John Wiley and Sons Australia, Milton, Qld., pp. 423-454
Wilde, M.H., Bliss, D.Z., Booth, J., Cheater, F.M. and Tannenbaum, C., 2014. Self-management of urinary and fecal incontinence. AJN The American Journal of Nursing, 114(1), pp.38-45.
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